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Objectives

  • The goal of this course is to serve as an introduction for student doctors to learn the skills necessary to find out who their patient is as a person, to explore the impact of illness on that person's life, and to collect from that person the information necessary to provide competent health care in the context of an effective doctor-patient relationship.

Other components of this course include

Competencies

Professionalism

Shows professional attitudes and demeanor in interactions with patients, peers and faculty

Rapport

Attempts to engage patient, listens attentively, does not interrupt inappropriately; is respectful, humble and non-judgmental

Empathy

Explores patient's underlying feelings, and validates them by conveying an understanding of them

Medical History

Shows an organized approach to eliciting data, knows what information to collect from each part of the history (CC, HPI, PMH, FH, SH)

Patient-Centered Perspective

Seeks to understand and respect patient's background, culture, and belief systems

Growth toward Physician Role

Assumes physician role in the doctor-patient relationship

Oral Presentations

Presents clinical material in a coherent, organized, accurate and concise manner

Written Documentation

Translates interactions with patients into coherent, organized, accurate written summaries

Group Participation

Engages in group discussions, interacts respectfully with peers

Constructive Feedback

Gives timely and specific feedback to peers respectfully. Is open to feedback from peers and section leaders

Reflective Practice

Demonstrates thoughtful personal integration of patient interactions through journaling and group participation

Expected Professional Attitudes

Consider this your first clinical rotation—you are now a student doctor in training, and this means that your role of student is different from that of previous student experiences. As a professional, you should approach learning in the course as part of the doctor-patient covenant and show the professional attitude and demeanor that is part of a physician's role as follows:

  • Be open-minded and not defensive

  • Use appropriate demeanor, language and dress for a medical professional

  • Have humility as well as maturity

  • Adherence to boundaries (no after-interview patient visits)

  • Respect for section leader and peers

  • Follow appropriate channels for conflict resolution

  • Look involved

  • Attend lectures and small group sections (attendance is MANDATORY and will be taken at the start of class with your Iclicker; excused absences must be approved by the OSA)

  • Be on time

  • No talking during lecture or demonstration patient interviews

  • No eating in the lecture hall

  • No wearing of hats in the lecture hall

  • No sitting with legs over the chair in front of you

  • All telephones, beepers, etc. should be turned off during lecture

  • Keep and submit a doctor-patient journal

Small Group Learning Objectives and Structure

Learning Objectives

By the end of the section meetings students will have demonstrated the ability to:

  • Interact respectfully with peers about a clinical interaction.

  • Provide specific feedback to peers that highlights both strengths and areas for improvement.

  • Receive feedback in a non-defensive manner and respond to suggestions.

  • Summarize information collected concisely, construct a coherent, organized and accurate life story, and medical history of the patient, and present it orally to peers.

  • Translate an interpersonal interaction with a patient into a coherent, organized and accurate written summary as described in the journal instructions.

  • Discuss concepts addressed in lectures.

  • Apply lecture topics to encounters with patient/residents.

Small Group Structure

Meetings will consist of:

  • Opening: Group of 2 section leaders and 8 TMS 1s.

    • Discussion of lecture and students' journal entries from previous week.

  • Interview: Subgroups of 1 Section Leader and 4 TMS 1s.

    • Interviewing of patients/residents with feedback from section leader.

  • Wrap-up: Group of 2 section leaders and 8 TMS 1s. Presentation of interview and discussion.

    • Present Thank You Cards written by students to JCHE residents and Signed

    • Form Letter to hospitalized patients

Medical Interpreter Experience

Each small group will have the opportunity to work with a trained medical interpreter while interviewing a resident at Jewish Community Housing for the Elderly (JCHE). This will allow students to practice their cross-cultural communication skills and review the proper procedure for working with a medical interpreter.

Each small group leader at JCHE will sign their group up to work with the interpreters on a specific date, so that the group can prepare ahead of time. It will be helpful to review the readings on cross cultural communication and medical interpreter use in the syllabus in advance of your group's session as your small group interpreter experience may occur before the lecture on cross-cultural interviewing.

Readings

Lisa I. Iezzoni. Eliminating Health And Health Care Disparities Among The Growing Population Of People With Disabilities. Health Affairs, 30, no.10 (2011):1947-1954.

Student Evaluation

Continuing Feedback

Students will receive weekly feedback on their interviews, journal write-ups and presentations of patients and readings from section leaders and peers.

Practice OSCE

Each group of students will have an opportunity to work with standardized patients during one of the weeks of the JCHE rotations. This is designed to both practice your interviewing and history taking skills as well as to give you experience with standardized patients for the final exam OSCE in addition to many other standardized patient exercises you will experience throughout your medical training.

Mid-Term and Final Evaluation

Section leaders will evaluate student's performance at the midterm and at the end of the course (See Student Evaluation Form).

At the mid-course change of interviewing site, students will bring the midterm evaluation they receive from their section leader to their new section leader at their new assigned site.

Final Exam

The final exam will consist of an interviewing encounter with a standardized patient at TUSM Clinical Skills and Simulation Center. The standardized patient will evaluate student's interviewing competencies based on the overall course competencies listed on the syllabus.

Grading

Students must pass the final evaluation and the final exam.

Journal

Why is there a Journal Assignment?

Doctors write. They write progress notes, case presentations, some write in academic journals. Others write narratives of their encounters with patients. This journal is a way for you to begin writing down data gathered from the interview, your observations of patients, as well as your own reactions to the patient and the interview. Learning to write about encounters with patients is an important beginning to establishing yourself in the role of physician.

The journal is also a vehicle for reflection, a way for you to organize your thoughts about your experience. Some of the most important learning physicians do comes not from medical journals but from their experiences. What worked? What didn't? What else to did you need to know to help the patient? How can I do it better next time? Reflective journaling gives you an opportunity to think in-depth about your experiences and in the process, improve your practice of medicine. Many students re-read their journals as they move through medical school, and find it helpful to see how much they've grown since there first days as a medical student.

Your journal is also an avenue for your section leader to get to know you and to facilitate your development into an empathic interviewer and effective physician. Your section leader will provide you with constructive feedback about your journal and base some of your overall course grade on your journals.

Journal Logistics

Email your most recent journal entry only (as an attachment, PC compatible using MS Word) to your section leader each week by Monday 9am, including your name and the date of the interview. This enables your section leader to get feedback to you about your entry by the following Thursday. The format should be no more than one page.

Your weekly journal entry should be written about the person you interviewed. If you did not interview that week, pick one other person whose interview you observed. Please write your journal entry in your own words as this is not meant to be a collaborative effort.

Journal Structure

Medical Data (1/3 page):

  • What is the Chief Concern (CC)?

  • What is the History of Present Illness (HPI)?

  • What is the Social History? (Please include this after week 4 of the course)

  • How, if at all, were you able to practice the specific competencies pertaining to this week's lectures during this interview?

Life Story (1/3 page):

  • Who is this patient/resident as a person?

  • What did you learn about this person/life story?

Reflection on the Interviewing Process (1/3 page):

  • How did the interviewer begin to establish a doctor-patient relationship and conduct a medical interview? What specifically was done well? What could have been done better?

  • How, if at all, could the patient/resident story affect your relationship with them as their physician?

  • How, if at all, could the patient/resident story affect your perception of yourself and your own relationships?

Student Evaluation Form

Section Leaders Evaluation Form